| NPI | 1740918887 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LESLIE ELMER Director, Credentialing And Risk 815-381-7431 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center Ambulatory Surgical |
| Enumeration Date | 2022-08-08 |
| Last Update Date | 2023-06-06 |